Provider Demographics
NPI:1295827004
Name:NORTH MISSISSIPPI SPINE CENTER, INC
Entity Type:Organization
Organization Name:NORTH MISSISSIPPI SPINE CENTER, INC
Other - Org Name:NORTH MISSISSIPPI SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OF CLINICAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGETTE
Authorized Official - Middle Name:ROCKETTE
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:662-563-7728
Mailing Address - Street 1:PO BOX 1204
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-1204
Mailing Address - Country:US
Mailing Address - Phone:662-563-7728
Mailing Address - Fax:662-563-4888
Practice Address - Street 1:109 EUREKA STREET
Practice Address - Street 2:SUITE B
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606
Practice Address - Country:US
Practice Address - Phone:662-563-7728
Practice Address - Fax:662-563-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS25C0001060261QA1903X
MS542011293D00000X
MS335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No293D00000XLaboratoriesPhysiological Laboratory
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04584863Medicaid
MS00122658Medicaid
MS05001777Medicaid
MS05621095Medicaid
MS5521760001OtherNSCSSUPP DMEPOS
MS00015663Medicaid
Y36536Medicare UPIN
MS00122658Medicaid
MS302I147961Medicare PIN
MS05001777Medicaid